高頻率電針穴位對膝關節鏡手術術後止痛療效之評估

The Effect of High-Frequency Electroacupuncture on Post-Arthroscopic Pain

目前在處理手術後疼痛的技術上雖已有長足的進步，然而其無非是需要專門之技術或是存在著許多藥物的副作用，如常用鴉片類止痛劑有呼吸抑制、噁心、嘔吐、搔癢及成癮性等副作用。針灸是中國傳統醫學中已經為世界衛生組織所認同的一項醫療方式，而針灸止痛也已受到國內外醫學研究者的重視；且針灸並無明顯不良副作用，而針刺穴位止痛於中國傳統醫學已行之有年，本研究探討電針刺激陽陵泉及陰隨泉穴對膝關節鏡手術術後止痛放果之評估，期能以中西醫學綜合方式來處理手術後的疼痛問題。本研究以接受膝關節鏡手術患者為對象，依美國麻醉協會分類為第一級病人（ASAclassI；即身體健康並無任何系統性疾病者），在取得為人同意後，於手術前三十分鐘依隨機取樣分為三位：即對照組、偽假電針組、術前電針組。每組各二十位病人，於手術後記錄病患麻醉及手術時間，術後第一次要求止痛藥時間是二十四小時病患自控式止痛（Patient-Controlled Analgesia﹔PCA）所使用的嗎啡總量：並且觀察記錄為辜的生命徵候（vitalsigns）、疼痛分數（VAS score）及藥物的副作用等，將收集之資料進行統計分析，以確認各項在統計學上是否有明顯差異（P<0.05）。對照組、偽假電針組、術前電針組病人在術後至第一次要求止痛藥的時間平均值分別為9.90±0.59、22.10±2.26及47.25±2.47分鐘，各組悶在統計學上具有顯著的差異。在術後二十四小時內PCA嗎啡的使用總劑量上，對照組、偽假電針組及術前電針組分別為16.25±1.29mg、11.35±0.87mg及6.30±0.88mg各組間在統計學上亦具有顯著的差異。三組在疼痛分數的比較上，當手術結束麻醉清醒時（即第0小時）、第0.5及1.0小時，對照組的疼痛分數VAS score高於偽假電針組及術前電針組，且具統計學上顯著的意義；至於其他時間點的疼痛分數，各組間並沒有差異。最後統計鴉片類藥物的副作用發生率，得知在術前電針組術後噁心眩暈的發生率都較對照組為低，且具有統計學上的意義。針刺鎮痛存在著安慰劑效應（placeboeffect），且術前電針的確是能延長術後第一次要求止痛藥的時間，及在術後二十四小時內PCA嗎啡的使用總需求量，達到更好的術後止痛。

BACKGROUND: Postoperative pain is one of the major complains by the patients after surgery. Recent evidence supports the worldwide use of acupuncture to relief pain in clinical practice. Numerous study have found that acupuncture activates multiple neurophysiological interactions, and decreases nociceptive responses in animals receiving painful thermal, chemical, and electrical stimulations. In the present study, we examined the effects of electroacupuncture (EA) at classical acupuncture points (Yanglingquan and Yinglingquan) on postoperstive pain. METHODS: Sixty patients (ASA class I) undergoing arthroscopic surgery of knee were randomly assigned to three treatment regimens: Group I (N=20), control group; Group II (N=20), sham-EA (needle intradermal insertion without electrical stimulation); Group III (N=20), pre-operative EA (pre-op EA; needle inseration with 100 Hz electrical stimulatiuon 30 min prior to anesthesia). All patients received patient-controlled analgesia (PCA) of morphine postoperation. The post- operative pain was evaluated by recording (1) the time of the first required analgesic, (2) the total amont of morphine required by PCA, and (3) Patients' VAS score, (4) the opioid-related side effect. RESULTS: We found that the time of first analgesic required was 9.90±0.59' 22.10±2.26 and 47.25± 2.47 minutes in the control, sham-EA and preoperative EA groups. During the first 24 hours, the total amount of morphine required was 16.25± 1.29 mg' 11.35±0.87 mg and 6.30±0.88 mg in the control, sham-EA and preoperative EA groups, respectively. There were significant in statistics by comparing with each other. The incidence of nausea and dizziness during the first 24 hours after surgery was significantly reduced in pre-op EA groups compared with the control group. We also found that sham-EA exerts a beneficial effect with respect to its pain relieving quality but not the side effect profiles. CONCLUSIONS: The present study showed that pre-operative EA group postpone the initial demand for pain control and decrease total PCA dosage within 24 hours.